Evaluating predictors of clinical reasoning competency: A cross-sectional study of the role of systems thinking in Iranian clinical nurses

The complexity of healthcare delivery necessitates a comprehensive understanding of clinical practice and the systems within which it operates. The clinical reasoning competency is essential for nurses as they navigate the complexities of patient care, encompassing cognitive processes that enable informed decision-making and effective interventions. This study investigated the determinants of clinical reasoning competency among nurses in Ardabil, Iran, addressing the limited empirical evidence in Iranian nursing practice. In this cross-sectional study conducted in Ardabil, Iran, 400 clinical nurses were recruited through simple random sampling from five teaching and treatment hospitals. Eligible participants were registered nurses with at least a bachelor’s degree and more than six months of clinical experience. Data were collected using a demographic form, the clinical reasoning competency scale, and the systems thinking scale. The study found significant relationships between demographic variables—age, work experience, and education—and clinical reasoning competency. Age (B=0.556, P=0.022), work experience (B=1.484, P=0.020), and education level (B=3.958, P<0.001) together accounted for 62.6% of the variance in clinical reasoning competency among nurses. Additionally, systems thinking (B=3.958, P<0.001) accounted for an additional 27.0% of the variance, reinforcing its role in enhancing clinical reasoning. The results underscore the critical role of education, clinical experience, and systems thinking in enhancing nurses’ clinical reasoning competency. Future research should examine the incorporation of standardized nursing languages (e.g., North American Nursing Diagnosis Association International, Nursing Interventions Classification/Nursing Outcomes Classification) into clinical reasoning frameworks and evaluate their effects on patient outcomes. Moreover, longitudinal and interventional studies are warranted to confirm these findings and guide the development of targeted training programs.